Ovidiu Coza | University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca (original) (raw)
Papers by Ovidiu Coza
Animal Science Papers and Reports, 2020
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
Concomitant chemoradiotherapy (CT/RT) is the gold standard for advanced cervical carcinoma, but w... more Concomitant chemoradiotherapy (CT/RT) is the gold standard for advanced cervical carcinoma, but with frequent debates over treatment schedules and toxicity. This study compared 2 concomitant CT/RT regimens in terms of quality of life (QoL) and acute toxicity. Between March 2003 and March 2005, 335 patients with stage IIB-IIIB cervical carcinoma were evaluated in a randomized single-center phase III trial at the Oncology Institute Cluj-Napoca. Patients received concurrent CT/RT with cisplatin 20 mg/m(2), days 1-5, every 21 days (arm A, n=171) or 40 mg/m(2)/weekly (arm B, n=164). QoL was estimated using the EORTC QLQ-30, v.3.0 questionnaire and acute toxicity using the common toxicity criteria (CTC) v.2.0. Significant improvement of global health status (p <0.01) and a decrease in pain (p <0.01) was observed in arm A. In arm B fatigue increased (p=0.01) and role functioning diminished (p=0.05). In both arms depression, nausea, vomiting and diarrhea increased (p <0.05). Gastro...
ePoster, 2019
Introduction/Background After the published guidelinesof Group Européen de Curiethérapie and Euro... more Introduction/Background After the published guidelinesof Group Européen de Curiethérapie and European Society for Radiotherapy andOncology (GEC-ESTRO) for tridimensional image-guided brachytherapy, many cancercenters have started abandoning the bidimensional conventional brachytherapy(2D-BT). The purpose of this study was to analyze the transition from 2D-BT totridimensional computed tomography-guided brachytherapy (CT-BT) and its effectson target and organs at risk in cervical cancer patients treated in ourinstitution. Methodology We performed a retrospectiveanalysis of 308 patients diagnosed with cervical cancer between 2016 and 2018.All patients were treated with primary chemoradiation, followed by CT-BT. Foreach patient we used a tandem-ring applicator and retrospectively realized one2D-BT plan with dose prescribed in International Commission on Radiation Unitsand Measurements (ICRU) point A and equal dwell times and a second plan withdose prescribed to the high-risk clinical target volume (HR-CTV) and differentdwell times. Results When prescribed to ICRUreference points, the mean dose to point A was 99.88% of the prescription dose(PD), the mean ICRU bladder and rectum point dose was 102.38% and 100.79% ofPD, respectively. When prescribed to HR-CTV, the mean dose to irradiated volumewas 96.6% of the PD, mean D2cc for bladder and rectum was 86.76% and 65.58% ofPD, respectively. Mean volume of 100% dose was 106.5cc vs 78.25cc whenprescribing to point A vs HR-CTV. Conclusion The study showed a reduction ofthe irradiated volume by 23.3% when the prescription of dose was done to HR-CTVcompared to point A, the D2cc for bladder and rectum were also lowered. Inconclusion, the old and never-ending love story of 2D-BT and CT-BT has to cometo an end in our institution, in order for the tridimensional image-guidedbrachytherapy techniques to write their own story and for cervical cancer tostop getting the principal role. Disclosure Nothing to disclose.
Bosnian journal of basic medical sciences, 2021
Implementation of precision medicine in lung cancer has benefited from intense research in the pa... more Implementation of precision medicine in lung cancer has benefited from intense research in the past years, developing subsequently an improved quality of life and increased overall survival of the patients. Targeted therapy has become one of the most important therapeutic innovations for the non-small cell lung cancer (NSCLC) category with anaplastic lymphoma kinase (ALK) gene rearrangement. The aim of this review is to provide a through overview of the main molecules of ALK tyrosine kinase inhibitors (TKI) with their general and particular mechanisms of resistance, the main methods of ALK gene detection, each with advantages and limits and the future perspectives currently under research which try to overcome the mechanisms of resistance. We have used two of the most reliable medical databases EMBASE and PubMed to properly select the latest and the most relevant articles for this topic. Encouraged by the promising results, the clinical practice was enriched by the approval of tyros...
Strahlenther Onkol, 2009
Purpose: To prove the superiority of concurrent radiochemotherapy (RTCT) over radiotherapy (RT) a... more Purpose: To prove the superiority of concurrent radiochemotherapy (RTCT) over radiotherapy (RT) alone in locally advanced cervical carcinoma. Patients and Methods: In this randomized monocentric phase III study, 566 patients with squamous cell carcinoma of the cervix were included: 284 in arm A (RT) and 282 in arm B (concurrent RTCT with cisplatin 20 mg/m2 × 5 days). 238 patients (42%) were in stage IIB, 209 (37%) in stage IIIA, and 119 (21%) in stage IIIB. The median follow-up was 62.8 months. RT to the pelvis was delivered to a dose of 46 Gy/23 fractions. A cervical boost was given using the X-ray arch technique or high-dose-rate intracavitary brachytherapy at a dose of 10 Gy. Thereafter, patients were evaluated: those with good response optionally underwent surgery and the others continued RT until 64 Gy/pelvis (with or without CT according to randomization) and 14 Gy/central tumor volume. Results: The 5-year survival rate was statistically significantly superior in the concurrent RTCT group (74%) versus the RT group (64%; p < 0.05). In patients undergoing surgery after RT or RTCT, superior results were obtained, compared to the nonoperated patients: 5-year survival rate 86% versus 53% (p < 0.01). 192 failures were recorded: 109 (38%) after RT alone versus 83 (29%) after concurrent RTCT (p < 0.01). Conclusion: The results of this study prove the obvious superiority of concurrent RTCT with 5-day cisplatin compared to RT alone in patients with locally advanced cervical carcinoma, regarding local control (78% vs. 67%) and 5-year survival rates (74% vs. 64%). Ziel: Nachweis der Überlegenheit einer begleitenden Radiochemotherapie (RTCT) gegenüber alleiniger Radiotherapie (RT) beim lokal fortgeschrittenen Zervixkarzinom. Patienten und Methodik: 566 Patientinnen mit Plattenepithelkarzinom der Zervix wurden eingeschlossen: 284 in Arm A (RT) und 282 in Arm B (RTCT, simultane CT mit Cisplatin 20 mg/m2 × 5 Tage). 238 Patientinnen (42%) waren im Stadium IIB, 209 (37%) im Stadium IIIA und 119 (21%) im Stadium IIIB. Der mediane Nachbeobachtungszeitraum betrug 62,8 Monate. Die perkutane RT wurde bis 46 Gy durchgeführt. Ein Zervixboost wurde mittels Brachytherapie oder perkutaner RT in Pendeltechnik mit 10 Gy appliziert. Anschließend wurden die Patientinnen neu beurteilt: Jene mit gutem Ansprechen wurden operiert und die anderen bis 64 Gy perkutan im Becken und zusätzlichen 14 Gy an der Zervix bestrahlt (mit/ohne CT je nach Randomisierung; Abbildung 1). Ergebnisse: Die 5-Jahres-Überlebensrate war in der simultanen RTCT-Gruppe statistisch signifikant besser (74%) als in der RT-Gruppe (64%; p < 0,05) (Abbildung 2). Bei Patientinnen mit gutem lokalen Ansprechen, welches eine Operation erlaubte, war die 5-Jahres-Überlebensrate im Vergleich zu den nichtoperierten Patientinnen statistisch signifikant besser: 86% versus 53% (p < 0,01; Abbildung 3). Die histologische Bewertung der Operationspräparate zeigte bei 64% der Patientinnen eine komplette Remission: in 71% (102/143) nach RTCT versus 56% (72/129) nach RT (p < 0,01; Tabellen 1 und 2). Bei histologisch vollständigem Ansprechen war die 5-Jahres-Überlebensrate signifikant höher als bei Nichtansprechen (Abbildung 4). Schlussfolgerung: Die Ergebnisse beweisen die Überlegenheit der RTCT mit Cisplatin gegenüber der alleinigen RT beim lokal fortgeschrittenen Zervixkarzinom.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
To evaluate the overall and disease-free survival of patients with advanced cervical carcinoma (F... more To evaluate the overall and disease-free survival of patients with advanced cervical carcinoma (FIGO stages IIB-IIIB) treated with external beam radiotherapy (EBRT) and medium dose rate brachytherapy (MDR-BT) plus/minus surgery. One hundred and seven patients received preoperative RT (group A) and 154 were treated with definitive RT (group B); 73 patients in both groups also received cisplatin as radiosensitizer. EBRT delivered as preoperative reached a total dose of 44-46 Gy/pelvis, whereas the definitive RT reached a total dose of 62-64 Gy with standard fractionation. MDR-BT was performed with a LDR/MDR Cs-137 Selectron machine; 10 Gy/point A were delivered in the preoperative group A and 14 Gy/point A/, 1-2 fractions in group B. Cisplatin as radiosensitizer was administered during EBRT at a dose of 20 mg/m(2)/day for 5 days with 21 days interval between cycles. With a median follow-up of 44.4 months (range 3.4-61.6) the overall survival at 3 years in group A was 92% vs. 68% for g...
Update in Intensive Care and Emergency Medicine, 1996
The introduction of modern neonatal intensive care units (NICUs) and the technological advances, ... more The introduction of modern neonatal intensive care units (NICUs) and the technological advances, used in these NICUs, have markedly improved the survival rates for all neonates. Improved survival has been most dramatic for very low-birth-weight (VLBW, 80%) and a potential for reversibility. Mortality has traditionally been the tool used to evaluate the success of NICU treatment. With the increasing survival rate the interest in the quality of survival was growing and consequently follow-up studies were undertaken. Adverse outcome in survivors was first mostly described in terms of major handicap and defined as “the presence of impairments that will prevent the child from leading a normal daily life”. Most major handicaps can be detected in the first year of life. Less severe impairments may go undetected until later in childhood, but may also be more amenable to intervention. Therefore, today both shortterm and longterm neurodevelopmental outcome must be evaluated in the NICU graduate.
Radiotherapy and Oncology, 2011
Strahlentherapie und Onkologie, 2009
Objective: to assess the efficiency of cleaning/disinfection of surfaces of an Intensive Care Uni... more Objective: to assess the efficiency of cleaning/disinfection of surfaces of an Intensive Care Unit. Method: descriptive-exploratory study with quantitative approach conducted over the course of four weeks. Visual inspection, bioluminescence adenosine triphosphate and microbiological indicators were used to indicate cleanliness/disinfection. Five surfaces (bed rails, bedside tables, infusion pumps, nurses' counter, and medical prescription table) were assessed before and after the use of rubbing alcohol at 70% (w/v), totaling 160 samples for each method. Non-parametric tests were used considering statistically significant differences at p<0.05. Results: after the cleaning/disinfection process, 87.5, 79.4 and 87.5% of the surfaces were considered clean using the visual inspection, bioluminescence adenosine triphosphate and microbiological analyses, respectively. A statistically significant decrease was observed in the disapproval rates after the cleaning process considering the three assessment methods; the visual inspection was the least reliable. Conclusion: the cleaning/disinfection method was efficient in reducing microbial load and organic matter of surfaces, however, these findings require further study to clarify aspects related to the efficiency of friction, its frequency, and whether or not there is association with other inputs to achieve improved results of the cleaning/disinfection process.
Radiotherapy and Oncology, 2011
MRI was done after insertion of a customised intrauterine single line source, followed by an MRI ... more MRI was done after insertion of a customised intrauterine single line source, followed by an MRI on Day 2 and Day 3. The HR CTV and OARs were contoured by a radiologist and reviewed by the treating radiation oncologist. A brachytherapy plan was optimised along the GEC ESTRO guidelines. Day 2 and Day 3 MRIs were compared to the Day 1 images and plan with regards to volumetric and dosimetric differences, with adequate dosimetry defined as HR CTV D90 ≥ 87Gy (EQD2). Results: 50 patients had volumetric and dosimetric data available for Day 1, 39 and 23 patients had MRIs on Day 2 and 3, respectively. The mean HR CTV on the Day 1 MRI was 30.4cm (range 10.6cm-74.6cm). HR CTV increased during treatment (mean 33.6 cm on Day 2 and 35.4cm on Day 3, p=0.0001), with an average increase of 15%. Mean Day 1 rectal volume was 54.6 cm with a mean increase in volume on Day 2 to 67.6cm (p=0.002).Adequate dosimetry was achieved in 92%, 66% and 50% of cases on Day 1, Day 2 and Day 3, respectively with a mean D90 on Day 1, 2, and 3 of 96.1Gy, 89.3Gy and 87.5Gy (p<0.0001). The mean Day 2 and Day 3 D90 of patients not achieving the GEC-ESTRO-defined D90 were 80Gy (range: 57.6 86.5Gy) and 81Gy (range 59.3 86.4Gy). It was observed that all patients with poor Day 1 dosimetry had subsequent poor dosimetry. 42% of those with poor dosimetry on any day had poor average dosimetry (mean D90 86.7Gy).There was no significant variation in bladder dosimetry over time. The mean Day 1 rectal 2cc dose was 69.9Gy. There was a mean difference of 4.2% and 4.5% on Day 2 on Day 3, with a significant increasing trend in dose over time (p=0.04). Conclusions: Reassuringly, the overall D90 over a 3 day period of PDR BT for 91% of patients met the GEC ESTRO criteria. This was despite a significant trend of D90 dosimetry decreasing over time and significant changes in HR CTV and rectal volumes on daily MRI imaging.
International Journal of Radiation Oncology*Biology*Physics, 2013
International Journal of Gynecological Cancer, 2012
The evaluation of 5-year results obtained through 2 radiochemotherapy (RCT) regimens: cisplatin (... more The evaluation of 5-year results obtained through 2 radiochemotherapy (RCT) regimens: cisplatin (CDDP), 20 mg/m × 5 days every 21 days; and CDDP, 40 mg/m per week in locally advanced cervical carcinoma. In this single-institution prospective randomized phase 3 study, 326 patients with stage IIB to IIIB squamous cell cervical carcinoma treated from March 2003 to March 2005 were included. One hundred sixty patients (49%) had stage IIB cervical carcinoma, 103 patients (31.5%) had stage IIIA cervical carcinoma, and 63 patients (19.5%) had stage IIIB cervical carcinoma. The patients were randomly assigned to 2 therapeutic arms: 164 patients in arm A (5 days) concurrent RCT with CDDP, 20 mg/m per day, days 1 to 5 every 21 days; and 162 patients in arm B (weekly), concurrent RCT with CDDP, 40 mg/m per day weekly. All patients were treated with external beam radiotherapy on the abdominopelvic region using 15-MV x-rays and a cervical boost using the x-rays arch technique or medium-dose-rate intracavitary brachytherapy. The 5-year survival rate obtained through the 2 RCT regimens are not statistically different, even if a tendency of superiority can be observed in the 5-day arm as far as overall survival (78% in arm A vs 72% in arm B; p = 0.14) and disease-free survival (73% in arm A and 69% in arm B; p = 0.09) are concerned. Five-year local relapse-free survival was significantly superior in the 5-day CDDP arm (87%) in comparison with the weekly CDDP arm (77%); p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01. In the 5-day arm, local relapse rate was twice lower, 21/164 (13%), compared with the weekly arm, 40/162 (25%); p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Distance failures were identical in the 2 therapeutic groups: 22/164 (13%) and 21/162 (13%), respectively, which shows the superiority of arm A regarding local control. The results of our study demonstrate that RCT with cisplatin, 20 mg/m × 5 days every 21 days, is superior regarding local efficacy and is less toxic compared with the weekly chemotherapy regimen.
European Journal of Cancer, 1999
Purpose: To estimate tolerance and effectiveness of the concomitant radiochemotherapy for advance... more Purpose: To estimate tolerance and effectiveness of the concomitant radiochemotherapy for advanced unresectable oropharyngeal cancer. Method: Cisplatinum 20 mg/m*/day d. O-4, 5-Fu 450 mg/m*/day d. O-6; than every week (days 13, 20, 27 etc) 5Fu 450 mg/mz one-day. Conventional fractionation 2 Gy daily starting day 1, total dose 66 Gy. In case of CR of the primary and only PR of lymph nodes-MRND 4. Inclusion criteria: unresectable squamous cell cancer (SCC) of the oropharynx T3-4 and/or N2-3, no distant secondaries, perf. status O-1 WHO, age < 70. Material: Fifty seven patients entered the study (52 M and 5 F, age 17 to 69 years). Stage: T2N2-3-10 pts. T3-4NO-1-12 pts, T3-4N2-3-35 pts. Patomorphology: SCC G2-26 pts, poorly differentiated SCC-31 pts. Tolerance: skin and mucosal reactions EORTC/RTOG classification: G3 in 27 pts. Breaks in radiation in 23 pts (in 2 over 10 days). All completed radiotherapy in planned total dose. Neutropenia was observed in 16 pts. Results: CR was obtained in 41/57 pts (72%). CR of the primary and PR
European Journal of Cancer, 1997
To evaluate of importance of hypoxia-related factors like abnonnal mean corpuscular volume (MCV),... more To evaluate of importance of hypoxia-related factors like abnonnal mean corpuscular volume (MCV), mean corpUSCUlar hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) in radiotherapy of laryngeal cancer. Material and Methods: In 295 patients WIth laryngeal cancer treated by definitive radiation therapy the MCV, MCH and MCHC were evaluated. The
Brachytherapy, 2009
ESTRO (2006) but there is still no consensus for the volume based dose constraints for the OARS. ... more ESTRO (2006) but there is still no consensus for the volume based dose constraints for the OARS. Objectives: To report the volumetric data of the ICBT 3-D image-based planning, done in our institute and look for any correlation between the doses received by the established ICRU rectal and bladder points and the computerized dose volume histogram (DVH) data of the OAR in ICBT for locally advanced cervix cancers. Methods and Materials: CT-based 3D-treatment plans (using Brachyvision software) of cervical cancer patients (Stage IIB-IVA), receiving intracavitary brachytherapy between December 2006 and August 2008 were prospectively analyzed. Prior to ICBT these patients received 50-60 Gy of external beam radiotherapy with midline block after 40 Gy. The intracavitary application procedure included instillation of 7 cc (cubic centimeters) of contrast material in the Foley catheter balloon, and posterior vaginal packing with radio-opaque gauge (with Fletcher applicator), as a part of other standard procedures. The dimensions of the prescribed isodose (width at the level of the ovoid tip; height along the long axis of the tandem); the tandem and ovoid loading; the volumes of the OAR rectum and bladder; the bladder and rectal point doses (points identified on the CT-based planning, based on the guidelines of rectal and bladder points of ICRU 38); the corresponding volumes receiving these doses and the DVH analysis of the doses received by 0.1 cc (D0.1), 1 cc (D1), 2 cc (D2) and 5 cc (D5) of the OAR were detailed. Results: The 3D-CT-based treatment plans of 26 patients receiving 7 Gy per fraction, for 3 fractions, of intracavitary brachytherapy were evaluated. Manchester and Fletcher applicators were used in 18 and 8 patients, respectively. The median central tandem loading used was 5 cm [4-6 cm] and ovoid loading was 2.5 cm. Median ovoid separation 144 Abstracts / Brachytherapy 8 (2009) 105e180
Vaginal and vulvar cancer, 2021
The reactions were evaluated on qualitative and semi-quantitative scale. Generalized Linear Model... more The reactions were evaluated on qualitative and semi-quantitative scale. Generalized Linear Model (GLM) and Cluster analysis were performed in R statistical environment. A distance plot compared the IHC panel of T with the correspondent N. Result(s)* Mismatch repair proteins (MMR), ER, PR and HER2/neu were excluded from data analysis because of homogeneous expression in all samples. Group A: the p16positive expression (surrogate of HPV-dependent pathway) was significantly higher (20.8% vs 6.2%, p = 0.04). Group B: PD-L1-positive and high EGFR expression were found respectively in 77.1% and 97.9% patients, (T and/or N). Overall, p16-negative tumors showed a higher PD-L1 expression (60.9% vs. 50.0%). In both groups tumoral immune infiltration (CD3 expression), was mainly moderate/intense (80% vs. 95%). VEGF showed strong/moderate-diffuse expression in 13.9% of T samples. CD31 was used to study tumoral micro vessel density (MVD) with no difference between Group A and Group B. p53 and PD-L1 showed a significant association with nodal metastasis. Odds ratio (OR) for p53 mutation was 4.26 (CI 95% = 1.14-15.87, p = 0.03); OR for PD-L1 positivity was 2.68 (CI 95% = 1.0-7.19, p < 0.05). The cluster analysis identified 3 and 4 subgroups of molecular profiles respectively in Group A and B, with no different prognosis. Moreover, the molecular profile of each N and corresponding T diverged significantly in 18/41 (43.9%) cases. Conclusion* These results support a potential role of immune checkpoint inhibitors and anti-EGFR drugs in a subset of patients with VSCC, especially with worse prognosis (metastatic, HPV-independent). It is mandatory to repeat the panel in the metastatic site to identify changes of marker expression.
Journal of Radiotheraphy & Medical Oncology December 2014 Vol.20 No 2: 47-53 Address for correspo... more Journal of Radiotheraphy & Medical Oncology December 2014 Vol.20 No 2: 47-53 Address for correspondence: Patricia Şuteu Prof. Dr. Ion Chiricuţă Oncology Institute Str. Republicii nr. 34-36 400015 Cluj-Napoca, Romania Email: patricia.suteu@gmail.com Background: In the Prof. Dr. Ion Chiricuţă Oncology Institute, treatment of stage IIB cervical cancer usually comprises surgery after radiochemotherapy (RCT). Aim: To compare the overall survival (OS), disease-free survival (DFS) and treatment failures after exclusive RCT versus RCT+surgery in patients with stage IIB cervical cancer included in a phase IIb single institution randomized trial. Material and methods: During September 2006November 2010, 111 patients with histologically confirmed cervical cancer stage IIB were randomly assigned in 2 arms: 59 in arm A with RCT+surgery and 52 in arm B with exclusive RCT. Treatment failure was defined as local recurrence, lymph node metastasis (lombo-aortic, supraclavicular) or organ metastasis. ...
Animal Science Papers and Reports, 2020
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
Concomitant chemoradiotherapy (CT/RT) is the gold standard for advanced cervical carcinoma, but w... more Concomitant chemoradiotherapy (CT/RT) is the gold standard for advanced cervical carcinoma, but with frequent debates over treatment schedules and toxicity. This study compared 2 concomitant CT/RT regimens in terms of quality of life (QoL) and acute toxicity. Between March 2003 and March 2005, 335 patients with stage IIB-IIIB cervical carcinoma were evaluated in a randomized single-center phase III trial at the Oncology Institute Cluj-Napoca. Patients received concurrent CT/RT with cisplatin 20 mg/m(2), days 1-5, every 21 days (arm A, n=171) or 40 mg/m(2)/weekly (arm B, n=164). QoL was estimated using the EORTC QLQ-30, v.3.0 questionnaire and acute toxicity using the common toxicity criteria (CTC) v.2.0. Significant improvement of global health status (p <0.01) and a decrease in pain (p <0.01) was observed in arm A. In arm B fatigue increased (p=0.01) and role functioning diminished (p=0.05). In both arms depression, nausea, vomiting and diarrhea increased (p <0.05). Gastro...
ePoster, 2019
Introduction/Background After the published guidelinesof Group Européen de Curiethérapie and Euro... more Introduction/Background After the published guidelinesof Group Européen de Curiethérapie and European Society for Radiotherapy andOncology (GEC-ESTRO) for tridimensional image-guided brachytherapy, many cancercenters have started abandoning the bidimensional conventional brachytherapy(2D-BT). The purpose of this study was to analyze the transition from 2D-BT totridimensional computed tomography-guided brachytherapy (CT-BT) and its effectson target and organs at risk in cervical cancer patients treated in ourinstitution. Methodology We performed a retrospectiveanalysis of 308 patients diagnosed with cervical cancer between 2016 and 2018.All patients were treated with primary chemoradiation, followed by CT-BT. Foreach patient we used a tandem-ring applicator and retrospectively realized one2D-BT plan with dose prescribed in International Commission on Radiation Unitsand Measurements (ICRU) point A and equal dwell times and a second plan withdose prescribed to the high-risk clinical target volume (HR-CTV) and differentdwell times. Results When prescribed to ICRUreference points, the mean dose to point A was 99.88% of the prescription dose(PD), the mean ICRU bladder and rectum point dose was 102.38% and 100.79% ofPD, respectively. When prescribed to HR-CTV, the mean dose to irradiated volumewas 96.6% of the PD, mean D2cc for bladder and rectum was 86.76% and 65.58% ofPD, respectively. Mean volume of 100% dose was 106.5cc vs 78.25cc whenprescribing to point A vs HR-CTV. Conclusion The study showed a reduction ofthe irradiated volume by 23.3% when the prescription of dose was done to HR-CTVcompared to point A, the D2cc for bladder and rectum were also lowered. Inconclusion, the old and never-ending love story of 2D-BT and CT-BT has to cometo an end in our institution, in order for the tridimensional image-guidedbrachytherapy techniques to write their own story and for cervical cancer tostop getting the principal role. Disclosure Nothing to disclose.
Bosnian journal of basic medical sciences, 2021
Implementation of precision medicine in lung cancer has benefited from intense research in the pa... more Implementation of precision medicine in lung cancer has benefited from intense research in the past years, developing subsequently an improved quality of life and increased overall survival of the patients. Targeted therapy has become one of the most important therapeutic innovations for the non-small cell lung cancer (NSCLC) category with anaplastic lymphoma kinase (ALK) gene rearrangement. The aim of this review is to provide a through overview of the main molecules of ALK tyrosine kinase inhibitors (TKI) with their general and particular mechanisms of resistance, the main methods of ALK gene detection, each with advantages and limits and the future perspectives currently under research which try to overcome the mechanisms of resistance. We have used two of the most reliable medical databases EMBASE and PubMed to properly select the latest and the most relevant articles for this topic. Encouraged by the promising results, the clinical practice was enriched by the approval of tyros...
Strahlenther Onkol, 2009
Purpose: To prove the superiority of concurrent radiochemotherapy (RTCT) over radiotherapy (RT) a... more Purpose: To prove the superiority of concurrent radiochemotherapy (RTCT) over radiotherapy (RT) alone in locally advanced cervical carcinoma. Patients and Methods: In this randomized monocentric phase III study, 566 patients with squamous cell carcinoma of the cervix were included: 284 in arm A (RT) and 282 in arm B (concurrent RTCT with cisplatin 20 mg/m2 × 5 days). 238 patients (42%) were in stage IIB, 209 (37%) in stage IIIA, and 119 (21%) in stage IIIB. The median follow-up was 62.8 months. RT to the pelvis was delivered to a dose of 46 Gy/23 fractions. A cervical boost was given using the X-ray arch technique or high-dose-rate intracavitary brachytherapy at a dose of 10 Gy. Thereafter, patients were evaluated: those with good response optionally underwent surgery and the others continued RT until 64 Gy/pelvis (with or without CT according to randomization) and 14 Gy/central tumor volume. Results: The 5-year survival rate was statistically significantly superior in the concurrent RTCT group (74%) versus the RT group (64%; p < 0.05). In patients undergoing surgery after RT or RTCT, superior results were obtained, compared to the nonoperated patients: 5-year survival rate 86% versus 53% (p < 0.01). 192 failures were recorded: 109 (38%) after RT alone versus 83 (29%) after concurrent RTCT (p < 0.01). Conclusion: The results of this study prove the obvious superiority of concurrent RTCT with 5-day cisplatin compared to RT alone in patients with locally advanced cervical carcinoma, regarding local control (78% vs. 67%) and 5-year survival rates (74% vs. 64%). Ziel: Nachweis der Überlegenheit einer begleitenden Radiochemotherapie (RTCT) gegenüber alleiniger Radiotherapie (RT) beim lokal fortgeschrittenen Zervixkarzinom. Patienten und Methodik: 566 Patientinnen mit Plattenepithelkarzinom der Zervix wurden eingeschlossen: 284 in Arm A (RT) und 282 in Arm B (RTCT, simultane CT mit Cisplatin 20 mg/m2 × 5 Tage). 238 Patientinnen (42%) waren im Stadium IIB, 209 (37%) im Stadium IIIA und 119 (21%) im Stadium IIIB. Der mediane Nachbeobachtungszeitraum betrug 62,8 Monate. Die perkutane RT wurde bis 46 Gy durchgeführt. Ein Zervixboost wurde mittels Brachytherapie oder perkutaner RT in Pendeltechnik mit 10 Gy appliziert. Anschließend wurden die Patientinnen neu beurteilt: Jene mit gutem Ansprechen wurden operiert und die anderen bis 64 Gy perkutan im Becken und zusätzlichen 14 Gy an der Zervix bestrahlt (mit/ohne CT je nach Randomisierung; Abbildung 1). Ergebnisse: Die 5-Jahres-Überlebensrate war in der simultanen RTCT-Gruppe statistisch signifikant besser (74%) als in der RT-Gruppe (64%; p < 0,05) (Abbildung 2). Bei Patientinnen mit gutem lokalen Ansprechen, welches eine Operation erlaubte, war die 5-Jahres-Überlebensrate im Vergleich zu den nichtoperierten Patientinnen statistisch signifikant besser: 86% versus 53% (p < 0,01; Abbildung 3). Die histologische Bewertung der Operationspräparate zeigte bei 64% der Patientinnen eine komplette Remission: in 71% (102/143) nach RTCT versus 56% (72/129) nach RT (p < 0,01; Tabellen 1 und 2). Bei histologisch vollständigem Ansprechen war die 5-Jahres-Überlebensrate signifikant höher als bei Nichtansprechen (Abbildung 4). Schlussfolgerung: Die Ergebnisse beweisen die Überlegenheit der RTCT mit Cisplatin gegenüber der alleinigen RT beim lokal fortgeschrittenen Zervixkarzinom.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
To evaluate the overall and disease-free survival of patients with advanced cervical carcinoma (F... more To evaluate the overall and disease-free survival of patients with advanced cervical carcinoma (FIGO stages IIB-IIIB) treated with external beam radiotherapy (EBRT) and medium dose rate brachytherapy (MDR-BT) plus/minus surgery. One hundred and seven patients received preoperative RT (group A) and 154 were treated with definitive RT (group B); 73 patients in both groups also received cisplatin as radiosensitizer. EBRT delivered as preoperative reached a total dose of 44-46 Gy/pelvis, whereas the definitive RT reached a total dose of 62-64 Gy with standard fractionation. MDR-BT was performed with a LDR/MDR Cs-137 Selectron machine; 10 Gy/point A were delivered in the preoperative group A and 14 Gy/point A/, 1-2 fractions in group B. Cisplatin as radiosensitizer was administered during EBRT at a dose of 20 mg/m(2)/day for 5 days with 21 days interval between cycles. With a median follow-up of 44.4 months (range 3.4-61.6) the overall survival at 3 years in group A was 92% vs. 68% for g...
Update in Intensive Care and Emergency Medicine, 1996
The introduction of modern neonatal intensive care units (NICUs) and the technological advances, ... more The introduction of modern neonatal intensive care units (NICUs) and the technological advances, used in these NICUs, have markedly improved the survival rates for all neonates. Improved survival has been most dramatic for very low-birth-weight (VLBW, 80%) and a potential for reversibility. Mortality has traditionally been the tool used to evaluate the success of NICU treatment. With the increasing survival rate the interest in the quality of survival was growing and consequently follow-up studies were undertaken. Adverse outcome in survivors was first mostly described in terms of major handicap and defined as “the presence of impairments that will prevent the child from leading a normal daily life”. Most major handicaps can be detected in the first year of life. Less severe impairments may go undetected until later in childhood, but may also be more amenable to intervention. Therefore, today both shortterm and longterm neurodevelopmental outcome must be evaluated in the NICU graduate.
Radiotherapy and Oncology, 2011
Strahlentherapie und Onkologie, 2009
Objective: to assess the efficiency of cleaning/disinfection of surfaces of an Intensive Care Uni... more Objective: to assess the efficiency of cleaning/disinfection of surfaces of an Intensive Care Unit. Method: descriptive-exploratory study with quantitative approach conducted over the course of four weeks. Visual inspection, bioluminescence adenosine triphosphate and microbiological indicators were used to indicate cleanliness/disinfection. Five surfaces (bed rails, bedside tables, infusion pumps, nurses' counter, and medical prescription table) were assessed before and after the use of rubbing alcohol at 70% (w/v), totaling 160 samples for each method. Non-parametric tests were used considering statistically significant differences at p<0.05. Results: after the cleaning/disinfection process, 87.5, 79.4 and 87.5% of the surfaces were considered clean using the visual inspection, bioluminescence adenosine triphosphate and microbiological analyses, respectively. A statistically significant decrease was observed in the disapproval rates after the cleaning process considering the three assessment methods; the visual inspection was the least reliable. Conclusion: the cleaning/disinfection method was efficient in reducing microbial load and organic matter of surfaces, however, these findings require further study to clarify aspects related to the efficiency of friction, its frequency, and whether or not there is association with other inputs to achieve improved results of the cleaning/disinfection process.
Radiotherapy and Oncology, 2011
MRI was done after insertion of a customised intrauterine single line source, followed by an MRI ... more MRI was done after insertion of a customised intrauterine single line source, followed by an MRI on Day 2 and Day 3. The HR CTV and OARs were contoured by a radiologist and reviewed by the treating radiation oncologist. A brachytherapy plan was optimised along the GEC ESTRO guidelines. Day 2 and Day 3 MRIs were compared to the Day 1 images and plan with regards to volumetric and dosimetric differences, with adequate dosimetry defined as HR CTV D90 ≥ 87Gy (EQD2). Results: 50 patients had volumetric and dosimetric data available for Day 1, 39 and 23 patients had MRIs on Day 2 and 3, respectively. The mean HR CTV on the Day 1 MRI was 30.4cm (range 10.6cm-74.6cm). HR CTV increased during treatment (mean 33.6 cm on Day 2 and 35.4cm on Day 3, p=0.0001), with an average increase of 15%. Mean Day 1 rectal volume was 54.6 cm with a mean increase in volume on Day 2 to 67.6cm (p=0.002).Adequate dosimetry was achieved in 92%, 66% and 50% of cases on Day 1, Day 2 and Day 3, respectively with a mean D90 on Day 1, 2, and 3 of 96.1Gy, 89.3Gy and 87.5Gy (p<0.0001). The mean Day 2 and Day 3 D90 of patients not achieving the GEC-ESTRO-defined D90 were 80Gy (range: 57.6 86.5Gy) and 81Gy (range 59.3 86.4Gy). It was observed that all patients with poor Day 1 dosimetry had subsequent poor dosimetry. 42% of those with poor dosimetry on any day had poor average dosimetry (mean D90 86.7Gy).There was no significant variation in bladder dosimetry over time. The mean Day 1 rectal 2cc dose was 69.9Gy. There was a mean difference of 4.2% and 4.5% on Day 2 on Day 3, with a significant increasing trend in dose over time (p=0.04). Conclusions: Reassuringly, the overall D90 over a 3 day period of PDR BT for 91% of patients met the GEC ESTRO criteria. This was despite a significant trend of D90 dosimetry decreasing over time and significant changes in HR CTV and rectal volumes on daily MRI imaging.
International Journal of Radiation Oncology*Biology*Physics, 2013
International Journal of Gynecological Cancer, 2012
The evaluation of 5-year results obtained through 2 radiochemotherapy (RCT) regimens: cisplatin (... more The evaluation of 5-year results obtained through 2 radiochemotherapy (RCT) regimens: cisplatin (CDDP), 20 mg/m × 5 days every 21 days; and CDDP, 40 mg/m per week in locally advanced cervical carcinoma. In this single-institution prospective randomized phase 3 study, 326 patients with stage IIB to IIIB squamous cell cervical carcinoma treated from March 2003 to March 2005 were included. One hundred sixty patients (49%) had stage IIB cervical carcinoma, 103 patients (31.5%) had stage IIIA cervical carcinoma, and 63 patients (19.5%) had stage IIIB cervical carcinoma. The patients were randomly assigned to 2 therapeutic arms: 164 patients in arm A (5 days) concurrent RCT with CDDP, 20 mg/m per day, days 1 to 5 every 21 days; and 162 patients in arm B (weekly), concurrent RCT with CDDP, 40 mg/m per day weekly. All patients were treated with external beam radiotherapy on the abdominopelvic region using 15-MV x-rays and a cervical boost using the x-rays arch technique or medium-dose-rate intracavitary brachytherapy. The 5-year survival rate obtained through the 2 RCT regimens are not statistically different, even if a tendency of superiority can be observed in the 5-day arm as far as overall survival (78% in arm A vs 72% in arm B; p = 0.14) and disease-free survival (73% in arm A and 69% in arm B; p = 0.09) are concerned. Five-year local relapse-free survival was significantly superior in the 5-day CDDP arm (87%) in comparison with the weekly CDDP arm (77%); p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01. In the 5-day arm, local relapse rate was twice lower, 21/164 (13%), compared with the weekly arm, 40/162 (25%); p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Distance failures were identical in the 2 therapeutic groups: 22/164 (13%) and 21/162 (13%), respectively, which shows the superiority of arm A regarding local control. The results of our study demonstrate that RCT with cisplatin, 20 mg/m × 5 days every 21 days, is superior regarding local efficacy and is less toxic compared with the weekly chemotherapy regimen.
European Journal of Cancer, 1999
Purpose: To estimate tolerance and effectiveness of the concomitant radiochemotherapy for advance... more Purpose: To estimate tolerance and effectiveness of the concomitant radiochemotherapy for advanced unresectable oropharyngeal cancer. Method: Cisplatinum 20 mg/m*/day d. O-4, 5-Fu 450 mg/m*/day d. O-6; than every week (days 13, 20, 27 etc) 5Fu 450 mg/mz one-day. Conventional fractionation 2 Gy daily starting day 1, total dose 66 Gy. In case of CR of the primary and only PR of lymph nodes-MRND 4. Inclusion criteria: unresectable squamous cell cancer (SCC) of the oropharynx T3-4 and/or N2-3, no distant secondaries, perf. status O-1 WHO, age < 70. Material: Fifty seven patients entered the study (52 M and 5 F, age 17 to 69 years). Stage: T2N2-3-10 pts. T3-4NO-1-12 pts, T3-4N2-3-35 pts. Patomorphology: SCC G2-26 pts, poorly differentiated SCC-31 pts. Tolerance: skin and mucosal reactions EORTC/RTOG classification: G3 in 27 pts. Breaks in radiation in 23 pts (in 2 over 10 days). All completed radiotherapy in planned total dose. Neutropenia was observed in 16 pts. Results: CR was obtained in 41/57 pts (72%). CR of the primary and PR
European Journal of Cancer, 1997
To evaluate of importance of hypoxia-related factors like abnonnal mean corpuscular volume (MCV),... more To evaluate of importance of hypoxia-related factors like abnonnal mean corpuscular volume (MCV), mean corpUSCUlar hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) in radiotherapy of laryngeal cancer. Material and Methods: In 295 patients WIth laryngeal cancer treated by definitive radiation therapy the MCV, MCH and MCHC were evaluated. The
Brachytherapy, 2009
ESTRO (2006) but there is still no consensus for the volume based dose constraints for the OARS. ... more ESTRO (2006) but there is still no consensus for the volume based dose constraints for the OARS. Objectives: To report the volumetric data of the ICBT 3-D image-based planning, done in our institute and look for any correlation between the doses received by the established ICRU rectal and bladder points and the computerized dose volume histogram (DVH) data of the OAR in ICBT for locally advanced cervix cancers. Methods and Materials: CT-based 3D-treatment plans (using Brachyvision software) of cervical cancer patients (Stage IIB-IVA), receiving intracavitary brachytherapy between December 2006 and August 2008 were prospectively analyzed. Prior to ICBT these patients received 50-60 Gy of external beam radiotherapy with midline block after 40 Gy. The intracavitary application procedure included instillation of 7 cc (cubic centimeters) of contrast material in the Foley catheter balloon, and posterior vaginal packing with radio-opaque gauge (with Fletcher applicator), as a part of other standard procedures. The dimensions of the prescribed isodose (width at the level of the ovoid tip; height along the long axis of the tandem); the tandem and ovoid loading; the volumes of the OAR rectum and bladder; the bladder and rectal point doses (points identified on the CT-based planning, based on the guidelines of rectal and bladder points of ICRU 38); the corresponding volumes receiving these doses and the DVH analysis of the doses received by 0.1 cc (D0.1), 1 cc (D1), 2 cc (D2) and 5 cc (D5) of the OAR were detailed. Results: The 3D-CT-based treatment plans of 26 patients receiving 7 Gy per fraction, for 3 fractions, of intracavitary brachytherapy were evaluated. Manchester and Fletcher applicators were used in 18 and 8 patients, respectively. The median central tandem loading used was 5 cm [4-6 cm] and ovoid loading was 2.5 cm. Median ovoid separation 144 Abstracts / Brachytherapy 8 (2009) 105e180
Vaginal and vulvar cancer, 2021
The reactions were evaluated on qualitative and semi-quantitative scale. Generalized Linear Model... more The reactions were evaluated on qualitative and semi-quantitative scale. Generalized Linear Model (GLM) and Cluster analysis were performed in R statistical environment. A distance plot compared the IHC panel of T with the correspondent N. Result(s)* Mismatch repair proteins (MMR), ER, PR and HER2/neu were excluded from data analysis because of homogeneous expression in all samples. Group A: the p16positive expression (surrogate of HPV-dependent pathway) was significantly higher (20.8% vs 6.2%, p = 0.04). Group B: PD-L1-positive and high EGFR expression were found respectively in 77.1% and 97.9% patients, (T and/or N). Overall, p16-negative tumors showed a higher PD-L1 expression (60.9% vs. 50.0%). In both groups tumoral immune infiltration (CD3 expression), was mainly moderate/intense (80% vs. 95%). VEGF showed strong/moderate-diffuse expression in 13.9% of T samples. CD31 was used to study tumoral micro vessel density (MVD) with no difference between Group A and Group B. p53 and PD-L1 showed a significant association with nodal metastasis. Odds ratio (OR) for p53 mutation was 4.26 (CI 95% = 1.14-15.87, p = 0.03); OR for PD-L1 positivity was 2.68 (CI 95% = 1.0-7.19, p < 0.05). The cluster analysis identified 3 and 4 subgroups of molecular profiles respectively in Group A and B, with no different prognosis. Moreover, the molecular profile of each N and corresponding T diverged significantly in 18/41 (43.9%) cases. Conclusion* These results support a potential role of immune checkpoint inhibitors and anti-EGFR drugs in a subset of patients with VSCC, especially with worse prognosis (metastatic, HPV-independent). It is mandatory to repeat the panel in the metastatic site to identify changes of marker expression.
Journal of Radiotheraphy & Medical Oncology December 2014 Vol.20 No 2: 47-53 Address for correspo... more Journal of Radiotheraphy & Medical Oncology December 2014 Vol.20 No 2: 47-53 Address for correspondence: Patricia Şuteu Prof. Dr. Ion Chiricuţă Oncology Institute Str. Republicii nr. 34-36 400015 Cluj-Napoca, Romania Email: patricia.suteu@gmail.com Background: In the Prof. Dr. Ion Chiricuţă Oncology Institute, treatment of stage IIB cervical cancer usually comprises surgery after radiochemotherapy (RCT). Aim: To compare the overall survival (OS), disease-free survival (DFS) and treatment failures after exclusive RCT versus RCT+surgery in patients with stage IIB cervical cancer included in a phase IIb single institution randomized trial. Material and methods: During September 2006November 2010, 111 patients with histologically confirmed cervical cancer stage IIB were randomly assigned in 2 arms: 59 in arm A with RCT+surgery and 52 in arm B with exclusive RCT. Treatment failure was defined as local recurrence, lymph node metastasis (lombo-aortic, supraclavicular) or organ metastasis. ...